Gynecologic Oncology Unit, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy.
Eur J Surg Oncol. 2013 Oct;39(10):1094-100. doi: 10.1016/j.ejso.2013.07.096. Epub 2013 Aug 12.
To analyze the preliminary experience of three gynecologic oncology services with minilaparoscopic radical hysterectomy (mLRH) for the treatment of cervical cancer and to compare perioperative outcomes with those of conventional laparoscopic surgery (LRH).
Prospectively collected data on consecutive cervical cancer patients undergoing radical hysterectomy with a laparoscopic approach were analyzed retrospectively. Perioperative outcomes of women undergoing mLRH were compared to data from control patients who had undergone LRH with 5-mm instruments. Adjustment for potential selection bias in surgical approach was made with propensity score (PS) matching.
The study cohort consisted of 257 patients, 35 undergoing mLRH and 222 undergoing LRH. The two groups were comparable in terms of demographic and tumor characteristics. No significant differences were observed between groups in terms of operative time, blood loss, lymph node yield, amount of parametrial or vaginal cuff tissue removed, and percentage of intra- or postoperative complications, both in the entire cohort and in the PS matched group. No conversions were needed from mLRH to standard laparoscopy or from minilaparoscopy to open surgery. Conversion from standard laparoscopy to open surgery was necessary in 2 patients. A shorter hospital stay was observed among women who had mLRH than in those undergoing LRH [2 (1-10) vs 4 (1-14) days, p = 0.005]. This difference remained significant after PS matching.
Our preliminary study suggests that in experienced hands minilaparoscopy is a feasible and safe technique for radical hysterectomy and yields results that are equivalent to those of LRH.
分析三个妇科肿瘤学服务机构在宫颈癌治疗中应用迷你腹腔镜根治性子宫切除术（mLRH）的初步经验，并将其与传统腹腔镜手术（LRH）的围手术期结果进行比较。
回顾性分析连续接受腹腔镜根治性子宫切除术的宫颈癌患者的前瞻性收集数据。将接受 mLRH 的女性的围手术期结果与接受 5mm 器械的 LRH 的对照患者的数据进行比较。通过倾向评分（PS）匹配来调整手术方法的潜在选择偏差。
研究队列包括 257 例患者，其中 35 例接受 mLRH，222 例接受 LRH。两组在人口统计学和肿瘤特征方面具有可比性。在整个队列和 PS 匹配组中，两组在手术时间、出血量、淋巴结产量、宫旁和阴道残端组织切除量以及术中或术后并发症的百分比方面均无显著差异。没有从 mLRH 转为标准腹腔镜或从迷你腹腔镜转为开放手术的病例。有 2 例需要从标准腹腔镜转为开放手术。接受 mLRH 的女性的住院时间短于接受 LRH 的女性[2（1-10）vs 4（1-14）天，p=0.005]。PS 匹配后，这一差异仍然显著。
我们的初步研究表明，在有经验的医生手中，迷你腹腔镜是一种可行且安全的根治性子宫切除术技术，其结果与 LRH 相当。
